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BMJ Clinical Evidence Jan 2016Leg ulcers usually occur secondary to venous reflux or obstruction, but 20% of people with leg ulcers have arterial disease, with or without venous disorders. Between... (Review)
Review
INTRODUCTION
Leg ulcers usually occur secondary to venous reflux or obstruction, but 20% of people with leg ulcers have arterial disease, with or without venous disorders. Between 1.5 and 3.0 in 1000 people have active leg ulcers. Prevalence increases with age to about 20 in 1000 people aged over 80 years.
METHODS AND OUTCOMES
We conducted a systematic overview, aiming to answer the following clinical questions: What are the effects of treatments for venous leg ulcers? What are the effects of organisational interventions for venous leg ulcers? What are the effects of advice about self-help interventions in people receiving usual care for venous leg ulcers? What are the effects of interventions to prevent recurrence of venous leg ulcers? We searched: Medline, Embase, The Cochrane Library, and other important databases up to March 2014 (Clinical Evidence overviews are updated periodically; please check our website for the most up-to-date version of this overview).
RESULTS
At this update, searching of electronic databases retrieved 116 studies. After deduplication and removal of conference abstracts, 63 records were screened for inclusion in the overview. Appraisal of titles and abstracts led to the exclusion of 43 studies and the further review of 20 full publications. Of the 20 full articles evaluated, four systematic reviews were updated and four RCTs were added at this update. We performed a GRADE evaluation for 23 PICO combinations.
CONCLUSIONS
In this systematic overview, we categorised the efficacy for 13 interventions based on information about the effectiveness and safety of advice to elevate leg, advice to keep leg active, compression stockings for prevention of recurrence, compression bandages and stockings to treat venous leg ulcers, laser treatment (low level), leg ulcer clinics, pentoxifylline, skin grafting, superficial vein surgery for prevention of recurrence, superficial vein surgery to treat venous leg ulcers, therapeutic ultrasound, and topical negative pressure.
Topics: Compression Bandages; Humans; Laser Therapy; Leg Ulcer; Negative-Pressure Wound Therapy; Skin Transplantation; Stockings, Compression; Treatment Outcome; Ultrasonography; Varicose Ulcer; Wound Healing
PubMed: 26771825
DOI: No ID Found -
Advances in Wound Care May 2021Chronic wounds impact the quality of life (QoL) of nearly 2.5% of the total population in the United States and the management of wounds has a significant economic... (Review)
Review
Chronic wounds impact the quality of life (QoL) of nearly 2.5% of the total population in the United States and the management of wounds has a significant economic impact on health care. Given the aging population, the continued threat of diabetes and obesity worldwide, and the persistent problem of infection, it is expected that chronic wounds will continue to be a substantial clinical, social, and economic challenge. In 2020, the coronavirus disease (COVID) pandemic dramatically disrupted health care worldwide, including wound care. A chronic nonhealing wound (CNHW) is typically correlated with comorbidities such as diabetes, vascular deficits, hypertension, and chronic kidney disease. These risk factors make persons with CNHW at high risk for severe, sometimes lethal outcomes if infected with severe acute respiratory syndrome coronavirus 2 (pathogen causing COVID-19). The COVID-19 pandemic has impacted several aspects of the wound care continuum, including compliance with wound care visits, prompting alternative approaches (use of telemedicine and creation of videos to help with wound dressing changes among others), and encouraging a do-it-yourself wound dressing protocol and use of homemade remedies/substitutions. There is a developing interest in understanding how the social determinants of health impact the QoL and outcomes of wound care patients. Furthermore, addressing wound care in the light of the COVID-19 pandemic has highlighted the importance of telemedicine options in the continuum of care. The economic, clinical, and social impact of wounds continues to rise and requires appropriate investment and a structured approach to wound care, education, and related research.
Topics: Acute Disease; Bandages; COVID-19; Chronic Disease; Delivery of Health Care; Diabetes Mellitus; Diabetic Foot; Education, Medical; Education, Nursing; Foot Ulcer; Humans; Leg Ulcer; Obesity; Overweight; Patient Education as Topic; Pressure Ulcer; SARS-CoV-2; Self Care; Social Determinants of Health; Telemedicine; United States; Varicose Ulcer; Wound Infection; Wounds and Injuries
PubMed: 33733885
DOI: 10.1089/wound.2021.0026 -
International Angiology : a Journal of... Apr 2018Venous leg ulcer (VLU) affects millions of people, and yet there have been no major advances in its treatment for many decades. Is it the time to change our approach,... (Randomized Controlled Trial)
Randomized Controlled Trial
BACKGROUND
Venous leg ulcer (VLU) affects millions of people, and yet there have been no major advances in its treatment for many decades. Is it the time to change our approach, and try a multidisciplinary one that could bring about a change? The aim of this study is to evaluate whether a regular, home-based exercise could be influential in healing the VLU.
METHODS
Eighty subjects (mean age: 65.13 years) were recruited for 12 weeks. The participants were randomized into a control group (N.=20), a compression therapy group (N.=20), an exercise group (N.=20) and a compression and exercise group (N.=20). The exercise comprised of 10 dorsiflexions each hour while the patient was awake. The first 2 groups did not perform any exercise while the other two did. Baseline and 3-month measurements were performed. These measurements include skin perfusion assessment and ulcer size.
RESULTS
All patients showed low tcPO2 in the beginning of the study. At the point of 3 months of exercise, Laser Doppler flowmetry and ulcer size measurements showed significant decrease, P<0.001 in exercise groups, however, no real change was demonstrated in the non-exercise groups. Subjects who were performing exercise showed significant increase in tcPO2 readings after 3 months (P<0.001), whereas the tcPO2 readings remained the same in the non-exercise groups.
CONCLUSIONS
We concluded that exercise had a significant effect on the VLU healing and this effect may be enhanced further with the help of the compression therapy. The tcPO2 and RF measurements may be seen as useful tools in evaluating the microvascular changes, and monitoring healing and follow up of the venous leg ulcer.
Topics: Aged; Aged, 80 and over; Blood Flow Velocity; Blood Gas Monitoring, Transcutaneous; Chronic Disease; Exercise Therapy; Female; Humans; Laser-Doppler Flowmetry; Leg Ulcer; London; Male; Microcirculation; Middle Aged; Regional Blood Flow; Skin; Time Factors; Treatment Outcome; Venous Insufficiency; Wound Healing
PubMed: 29368880
DOI: 10.23736/S0392-9590.18.03950-0 -
International Wound Journal Feb 2023This meta-review aimed to appraise and synthesise findings from existing systematic reviews that measured the impact of compression therapy on venous leg ulcers healing.... (Meta-Analysis)
Meta-Analysis Review
This meta-review aimed to appraise and synthesise findings from existing systematic reviews that measured the impact of compression therapy on venous leg ulcers healing. We searched five databases to identify potential papers; three authors extracted data, and a fourth author adjudicated the findings. The AMSTAR-2 tool was used for quality appraisal and the certainty of the evidence was appraised using GRADEpro. Data analysis was undertaken using RevMan. We identified 12 systematic reviews published between 1997 and 2021. AMSTAR-2 assessment identified three as high quality, five as moderate quality, and four as low quality. Seven comparisons were reported, with a meta-analysis undertaken for five of these comparisons: compression vs no compression (risk ratio [RR]: 1.55; 95% confidence interval [CI] 1.34-1.78; P < .00001; moderate-certainty evidence); elastic compression vs inelastic compression (RR: 1.02; 95% CI: 0.96-1.08; P < .61 moderate-certainty evidence); four layer vs
Topics: Humans; Compression Bandages; Varicose Ulcer; Stockings, Compression; Wound Healing; Data Analysis; Leg Ulcer
PubMed: 35855678
DOI: 10.1111/iwj.13891 -
Journal of the American Academy of... Dec 1991The treatment of leg ulcers is a common and sometimes difficult problem. They can be costly to treat and are associated with loss of working capacity and sometimes... (Review)
Review
The treatment of leg ulcers is a common and sometimes difficult problem. They can be costly to treat and are associated with loss of working capacity and sometimes significant morbidity. In the western world, leg ulcers are most frequently caused by venous insufficiency, arterial insufficiency, neuropathy (usually diabetic), or a combination of these factors. The pathogenesis, clinical features, and management of these types of leg ulcers are emphasized in this review.
Topics: Humans; Leg Ulcer
PubMed: 1810997
DOI: 10.1016/0190-9622(91)70295-d -
International Journal of Molecular... Jun 2022Venous leg ulcers (VLUs) are the most common type of leg ulcers with a significant socioeconomic burden due to slow healing. Cytokines may be involved in the... (Review)
Review
Venous leg ulcers (VLUs) are the most common type of leg ulcers with a significant socioeconomic burden due to slow healing. Cytokines may be involved in the pathogenesis of VLUs. In this systematic review, our objective was to investigate the association between cytokine levels, including growth factors, with the healing of VLUs. PubMed, Embase, Web of Science and Cochrane Library were searched from their inception to August 2021. We retrieved 28 articles investigating 38 different cytokines in 790 patients. Cytokines were most commonly investigated in wound fluid and less frequently in biopsies and serum. The studies were judged as having a moderate to high risk of bias, and the results were often inconsistent and sometimes conflicting. A meta-analysis was not performed due to clinical and methodological heterogeneities. We found weak evidence for elevated IL-1α, IL-6, IL-8, TNF-α and VEGF levels in non-healing VLUs, an elevation that declined with healing. TGF-β1 levels tended to increase with VLU healing. Other cytokines warranting further investigations include EGF, FGF-2, GM-CSF, IL-1β, IL-1Ra and PDGF-AA/PDGF-BB. We conclude that non-healing VLUs may be associated with an elevation of a palette of pro-inflammatory cytokines, possibly reflecting activated innate immunity in these wounds. There is a paucity of reliable longitudinal studies monitoring the dynamic changes in cytokine levels during wound healing.
Topics: Cytokines; Humans; Leg Ulcer; Varicose Ulcer; Vascular Endothelial Growth Factor A; Wound Healing
PubMed: 35742965
DOI: 10.3390/ijms23126526 -
BMJ Case Reports May 2013An elderly woman with a rapidly progressing lower leg ulcer presented with features of systemic inflammatory response syndrome (SIRS). The ulcer had occurred after...
An elderly woman with a rapidly progressing lower leg ulcer presented with features of systemic inflammatory response syndrome (SIRS). The ulcer had occurred after hitting her leg against a piece of luggage. The causative pathogen in our case was by Corynebacterium ulcerans, demonstrated in bacterial cultures and by PCR. Disease progression was stopped only by Linezolid intravenous. after several other antibiotics failed to help. Diphtheria is known to most physicians as a respiratory disease caused by Corynebacterium diphtheria which is occurring in the developed world infrequently because of widespread use of immunisation programmes. However, cutaneous infection with diphtheria is increasingly being diagnosed.
Topics: Acetamides; Aged, 80 and over; Anti-Bacterial Agents; Corynebacterium; Corynebacterium Infections; Female; Humans; Leg Injuries; Leg Ulcer; Linezolid; Oxazolidinones; Skin; Systemic Inflammatory Response Syndrome
PubMed: 23661657
DOI: 10.1136/bcr-2013-009260 -
Journal of Vascular Surgery Mar 2009Venous ulcers continue to cause problems for patients and health care systems. These are painful and unpleasant for the patient and expensive for health care providers... (Review)
Review
Venous ulcers continue to cause problems for patients and health care systems. These are painful and unpleasant for the patient and expensive for health care providers to treat. This brief review highlights effective methods of management. There is level 1 evidence of the efficacy of compression (bandaging or stockings) in healing ulcers as well as maintaining healing. Patients with superficial saphenous reflux, with or without perforating and deep vein incompetence, benefit from superficial venous surgery. This does not speed ulcer healing but is effective at preventing recurrence after healing with compression. Minimally invasive methods of managing incompetence of superficial saphenous trunks, including endovenous laser ablation, radiofrequency ablation, and foam sclerotherapy are probably also effective in treating patients with venous leg ulcers. Perforating vein ligation is commonly combined with superficial venous surgery for leg ulcer patients, but no systematic data are available to define the role of this treatment. Some centers use deep vein reconstruction to restore competence to deep vein valves. Insufficient data have been published to allow any general recommendation to be made for this treatment. A limited number of drugs have efficacy in promoting leg ulcer healing. They may be used in combination with compression treatment in patients with ulcers refractory to other methods of management. No particular ulcer dressing has been shown to be effective in speeding ulcer healing.
Topics: Bandages; Cardiovascular Agents; Catheter Ablation; Combined Modality Therapy; Evidence-Based Medicine; Humans; Laser Therapy; Leg Ulcer; Ligation; Practice Guidelines as Topic; Sclerotherapy; Stockings, Compression; Treatment Outcome; Varicose Ulcer; Vascular Surgical Procedures; Wound Healing
PubMed: 19268785
DOI: 10.1016/j.jvs.2009.01.003 -
Acta Medica Portuguesa Aug 2018
Topics: Female; Humans; Leg Ulcer; Necrobiosis Lipoidica; Young Adult
PubMed: 30189174
DOI: 10.20344/amp.10477 -
International Journal of Molecular... Nov 2017Current biological treatments for non-healing wounds aim to address the common deviations in healing mechanisms, mainly inflammation, inadequate angiogenesis and reduced... (Review)
Review
Current biological treatments for non-healing wounds aim to address the common deviations in healing mechanisms, mainly inflammation, inadequate angiogenesis and reduced synthesis of extracellular matrix. In this context, regenerative medicine strategies, i.e., platelet rich plasmas and mesenchymal stromal cell products, may form part of adjuvant interventions in an integral patient management. We synthesized the clinical experience on ulcer management using these two categories of biological adjuvants. The results of ten controlled trials that are included in this systematic review favor the use of mesenchymal stromal cell based-adjuvants for impaired wound healing, but the number and quality of studies is moderate-low and are complicated by the diversity of biological products. Regarding platelet-derived products, 18 controlled studies investigated their efficacy in chronic wounds in the lower limb, but the heterogeneity of products and protocols hinders clinically meaningful quantitative synthesis. Most patients were diabetic, emphasizing an unmet medical need in this condition. Overall, there is not sufficient evidence to inform routine care, and further clinical research is necessary to realize the full potential of adjuvant regenerative medicine strategies in the management of chronic leg ulcers.
Topics: Humans; Leg Ulcer; Platelet-Rich Plasma; Wound Healing
PubMed: 29182584
DOI: 10.3390/ijms18122561